The present invention is in the field of surgical apparatus and methods and is more specifically directed to apparatus and methods for effecting ligation of the deep dorsal venous complex using a transurethral approach and a vesico-urethral anastomosis using a mechanical stapling procedure which avoid the shortcomings of the prior known procedures for such operations. The invention is also intended for general use in tubular anastomosis.
Our prior U.S. Pat. Nos. 4,848,367 and 4,873,977, which are incorporated herein by reference, respectively describe a method of effecting dorsal vein ligation and a stapling method and apparatus for vesicle-urethral re-anastomosis using an inflatable anvil assembly 2 which is inserted through the patient's urethra. Dorsal vein ligation is effected by inflating the inflatable bladder 80 of the anvil assembly 23 while it is in the urethra to radially distend the urethra against the dorsal vein to effect substantial compressive closure of the vein, and then ligating and transecting the dorsal vein. Stapling is effected using a circular female connector component 26 which is carried by the anvil assembly 23. Female connector component 26 is aligned with a circular male connector component 28 carried by a connector actuator 32, alignment being maintained by the inflation of anvil assembly 23. Male connector component 28 is then driven into mating engagement with female connector component 26 by actuator 32.
While the methods and apparatus disclosed in our prior patents provide satisfactory results, problems remain. For example, once compressive closure of the dorsal vein is effected in accordance with the method disclosed in U.S. Pat. No. 4,848,367, suturing of the dorsal vein must still be done in a "blind" area, making it difficult to position the ligating suture optimally with respect to the apical urethral sphincter. Also, the anastomosis effected by female and male connector components 26 and 28 is shorter and narrower than would be optimally desirable, and thus does not fully prevent bladder neck stenosis and urethral stricture.